Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial.

OBJECTIVES: To assess a remote physiotherapist (PT) counselling intervention using self-monitoring tools for improving self-management ability, physical activity participation, and health outcomes in people with rheumatoid arthritis (RA). METHODS: Eligible participants were randomly assigned to receive group education, a Fitbit®, a self-monitoring app, and PT counselling phone calls (Immediate Group). The Delayed Group received a monthly e-newsletter until week 26, and then the intervention. The primary outcome was Patient Activation Measure (PAM-13). Participants were assessed at baseline, 27 weeks (the primary end point) and 53 weeks. Secondary outcomes included disease activity, pain, fatigue, depression, sitting/walking habits, daily physical activity time, and daily awake sedentary time. Generalized Linear Mixed-effect Models (GLMMs) were used to assess the effect of the intervention on the change of each outcome measure from the initiation to 27 weeks after the intervention. RESULTS: Analysis included 131 participants (91.6% women; 80.2% completed during the COVID-19 pandemic). The mean change of PAM-13 at 27 weeks was 4.6 (SD = 14.7) in the Immediate Group vs -1.6 (SD = 12.5) in the Delayed Group. The mean change in Delayed Group at 53 weeks (after the 26-week intervention) was 3.6 (SD = 14.6). Overall, the intervention improved PAM-13 at 27 weeks post-intervention from the GLMM analysis (adjusted coefficient: 5.3; 95% CI: 2.0, 8.7; p = <0.001). Favourable intervention effects were also found in disease activity, fatigue, depression, and self-reported walking habit. CONCLUSION: Remote counselling paired with self-monitoring tools improved self-management ability in people with RA. Findings of secondary outcomes indicate that the intervention had a positive effect on symptom management.

Partnering with people living with rheumatoid arthritis for care of their hands: Four case reports using relative motion orthoses.

STUDY DESIGN: Case report. INTRODUCTION: Despite better disease control with more effective medications, people with rheumatoid arthritis (RA) continue to experience persistent and fluctuating levels of pain, swelling and functional limitations in their hands. PURPOSE: To describe therapists and people living with RA working together to understand what could be occurring in their hands because of the RA and how relative motion (RM) orthoses may be used to self-manage common hand RA related problems. METHODS: Case reports are used to demonstrate how patient self-report, clinical exam, and observation of hand movement and function are integrated into the design of RM orthoses for individuals with RA. The cases are supported by photos and videos, including a personal narrative video exploring 1 persons' personal perspective on their use of RM orthoses. RESULTS: Case reports illustrate adaptive and/or protective RME orthoses use for RA related finger malalignment, tendon subluxation, joint pain and instability in the hand. The narrative video also introduces a person living with RA, who speaks candidly about her multiple RM orthoses and how she decides which orthosis is "best" for a given activity and the current level of RA related problems in her hands. DISCUSSION: It is not unusual for individuals with RA to have multiple RM orthoses, made for different purposes and fabricated from different materials. Mulitple RM orthosis options allows a person to select what is "best" for them, depending on the context of use and priorities or needs. CONCLUSION: Partnering with people living with RA to understand how to use simple, low-profile, adaptive and protective RM orthoses may be an effective way to support self-management of common RA related hand problems.

Relative motion orthoses: A five-question decision making tool for thinking beyond thermoplastics.

We introduce a five-question decision-making tool for using relative motion in practice. The tool considers the primary aim of the relative motion orthosis, the amount of relative motion required and the number of fingers that should be included. The tool also helps clincians consider the person-specific characteristics that will impact the use of the orthoses, as well as, a variety of materials that could be used to fabricate the relative motion orthosis. Clinical examples demonstrate the use of the decision tool and illustrate the varied use of relative motion orthoses.

The Impact of 51 Risk Factors on Life Expectancy in Canada: Findings from a New Risk Prediction Model Based on Data from the Global Burden of Disease Study.

The aims of this study were (1) to develop a comprehensive risk-of-death and life expectancy (LE) model and (2) to provide data on the effects of multiple risk factors on LE. We used data for Canada from the Global Burden of Disease (GBD) Study. To create period life tables for males and females, we obtained age/sex-specific deaths rates for 270 diseases, population distributions for 51 risk factors, and relative risk functions for all disease-exposure pairs. We computed LE gains from eliminating each factor, LE values for different levels of exposure to each factor, and LE gains from simultaneous reductions in multiple risk factors at various ages. If all risk factors were eliminated, LE in Canada would increase by 6.26 years for males and 5.05 for females. The greatest benefit would come from eliminating smoking in males (2.45 years) and high blood pressure in females (1.42 years). For most risk factors, their dose-response relationships with LE were non-linear and depended on the presence of other factors. In individuals with high levels of risk, eliminating or reducing exposure to multiple factors could improve LE by several years, even at a relatively advanced age.

Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice.

STUDY DESIGN: Electronic Web-based survey. INTRODUCTION: Evidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide. PURPOSE OF THE STUDY: The purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries. METHODS: Participation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their "most used" approach in the previous year. RESULTS: There were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%). DISCUSSION: In practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis. CONCLUSIONS: The RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.

Twenty-Four Hour Activity and Sleep Profiles for Adults Living with Arthritis: Habits Matter.

OBJECTIVE: To identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership. METHODS: Our study comprised a cross-sectional cohort and used baseline data from 2 randomized trials studying activity counseling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or knee osteoarthritis (OA). Participants wore activity monitors for 1 week and completed surveys for demographic information, mood (Patient Health Questionnaire 9), and sitting and walking habits (Self-Reported Habit Index). A total of 1,440 minutes/day were stratified into minutes off body (activity unknown), sleeping, resting, nonambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership. RESULTS: Our cohort included 172 individuals, including 51% with RA, 30% with OA, and 19% with SLE. We identified 4 activity-sleep profiles (clusters) that were characterized primarily by differences in time in nonambulatory activity: high sitters (6.9 hours sleep, 1.6 hours rest, 13.2 hours nonambulatory activity, and 1.6 hours intermittent and 0.3 hours purposeful walking), low sleepers (6.5 hours sleep, 1.2 hours rest, 12.2 hours nonambulatory activity, and 3.3 hours intermittent and 0.6 hours purposeful walking), high sleepers (8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory activity, and 2.5 hours intermittent and 0.3 hours purposeful walking), and balanced activity (7.4 hours sleep, 1.5 hours sleep, 9.4 hours nonambulatory activity, and 4.4 hours intermittent and 0.8 hours purposeful walking). Younger age (odds ratio [OR] 0.95 [95% confidence interval (95% CI) 0.91-0.99]), weaker occupational sitting habit (OR 0.55 [95% CI 0.41-0.76]), and stronger walking outside habit (OR 1.43 [95% CI 1.06-1.91]) were each associated with balanced activity relative to high sitters. CONCLUSION: Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.

Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial.

BACKGROUND: Current guidelines emphasize an active lifestyle in the management of knee osteoarthritis (OA), but up to 90% of patients with OA are inactive. In a previous study, we demonstrated that an 8-week physiotherapist (PT)-led counseling intervention, with the use of a Fitbit, improved step count and quality of life in patients with knee OA, compared with a control. OBJECTIVE: This study aimed to examine the effect of a 12-week, multifaceted wearable-based program on physical activity and patient outcomes in patients with knee OA. METHODS: This was a randomized controlled trial with a delay-control design. The immediate group (IG) received group education, a Fitbit, access to FitViz (a Fitbit-compatible app), and 4 biweekly phone calls from a PT over 8 weeks. Participants then continued using Fitbit and FitViz independently up to week 12. The delay group (DG) received a monthly electronic newsletter in weeks 1 to 12 and started the same intervention in week 14. Participants were assessed in weeks 13, 26, and 39. The primary outcome was time spent in daily moderate-to-vigorous physical activity (MVPA; in bouts ≥10 min) measured with a SenseWear Mini. Secondary outcomes included daily steps, time spent in purposeful activity and sedentary behavior, Knee Injury and OA Outcome Score, Patient Health Questionnaire-9, Partners in Health Scale, Theory of Planned Behavior Questionnaire, and Self-Reported Habit Index. RESULTS: We enrolled 51 participants (IG: n=26 and DG: n=25). Compared with the IG, the DG accumulated significantly more MVPA time at baseline. The adjusted mean difference in MVPA was 13.1 min per day (95% CI 1.6 to 24.5). A significant effect was also found in the adjusted mean difference in perceived sitting habit at work (0.7; 95% CI 0.2 to 1.2) and during leisure activities (0.7; 95% CI 0.2 to 1.2). No significant effect was found in the remaining secondary outcomes. CONCLUSIONS: A 12-week multifaceted program with the use of a wearable device, an app, and PT counseling improved physical activity in people with knee OA. TRIAL REGISTRATION: ClinicalTrials.gov NCT02585323; https://clinicaltrials.gov/ct2/show/NCT02585323.

Efficacy of a Physical Activity Counseling Program With Use of a Wearable Tracker in People With Inflammatory Arthritis: A Randomized Controlled Trial.

OBJECTIVE: To assess the efficacy of a multifaceted counseling intervention at improving physical activity participation and patient outcomes. METHODS: We recruited people with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). In weeks 1-8, the immediate group received education and counseling by a physical therapist, used a Fitbit and a web application to obtain feedback about their physical activity, and received 4 follow-up calls from the physical therapist. The delay group received the same intervention in weeks 10-17. Participants were assessed at baseline and at weeks 9, 18, and 27. The primary outcome was time spent in moderate/vigorous physical activity (MVPA; in bouts of ≥10 minutes) measured with a SenseWear device. Secondary outcomes included step count, time in sedentary behavior, pain, fatigue, mood, self-management capacity, and habitual behaviors. RESULTS: A total of 118 participants enrolled. The adjusted mean difference in MVPA was 9.4 minutes/day (95% confidence interval [95% CI] -0.5, 19.3, P = 0.06). A significant effect was found in pain (-2.45 [95% CI -4.78, -0.13], P = 0.04), and perceived walking habit (0.54 [95% CI 0.08, 0.99], P = 0.02). The remaining secondary outcomes improved, but were not statistically significant. Post hoc analysis revealed a significant effect in MVPA (14.3 minutes/day [95% CI 2.3, 26.3]) and pain (-4.05 [95% CI -6.73, -1.36]) in participants with RA, but not in those with SLE. CONCLUSION: Counseling by a physical therapist has the potential to improve physical activity in people with inflammatory arthritis, but further study is needed to understand the intervention effect on different diseases. We found a significant improvement in pain, suggesting that the intervention might have a positive effect on symptom management.

Can we improve cognitive function among adults with osteoarthritis by increasing moderate-to-vigorous physical activity and reducing sedentary behaviour? Secondary analysis of the MONITOR-OA study.

BACKGROUND: Preliminary evidence suggests osteoarthritis is a risk factor for cognitive decline. One potential reason is 87% of adults with osteoarthritis are inactive, and low moderate-to-vigorous physical activity and high sedentary behaviour are each risk factors for cognitive decline. Thus, we investigated whether a community-based intervention to increase moderate-to-vigorous physical activity and reduce sedentary behaviour could improve cognitive function among adults with osteoarthritis. METHODS: This was a secondary analysis of a six month, proof-of-concept randomized controlled trial of a community-based, technology-enabled counselling program to increase moderate-to-vigorous physical activity and reduce sedentary behaviour among adults with knee osteoarthritis. The Immediate Intervention (n = 30) received a Fitbit® Flex™ and four bi-weekly activity counselling sessions; the Delayed Intervention (n = 31) received the same intervention two months later. We assessed episodic memory and working memory using the National Institutes of Health Toolbox Cognition Battery. Between-group differences (Immediate Intervention vs. Delayed Intervention) in cognitive performance were evaluated following the primary intervention (i.e., Baseline - 2 Months) using intention-to-treat. RESULTS: The intervention did not significantly improve cognitive function; however, we estimated small average improvements in episodic memory for the Immediate Intervention vs. Delayed Intervention (estimated mean difference: 1.27; 95% CI [- 9.27, 11.81]; d = 0.10). CONCLUSION: This small study did not show that a short activity promotion intervention improved cognitive health among adults with osteoarthritis. However, the effects of increased moderate-to-vigorous physical activity and reduced sedentary behaviour are likely to be small and thus we recommend subsequent studies use larger sample sizes and measure changes in cognitive function over longer intervals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Protocol Registration System: NCT02315664 ; registered 12 December, 2014; https://clinicaltrials.gov/ct2/show/NCT02315664?cond=NCT02315664&rank=1.

Accuracy of Fitbit Devices: Systematic Review and Narrative Syntheses of Quantitative Data.

BACKGROUND: Although designed as a consumer product to help motivate individuals to be physically active, Fitbit activity trackers are becoming increasingly popular as measurement tools in physical activity and health promotion research and are also commonly used to inform health care decisions. OBJECTIVE: The objective of this review was to systematically evaluate and report measurement accuracy for Fitbit activity trackers in controlled and free-living settings. METHODS: We conducted electronic searches using PubMed, EMBASE, CINAHL, and SPORTDiscus databases with a supplementary Google Scholar search. We considered original research published in English comparing Fitbit versus a reference- or research-standard criterion in healthy adults and those living with any health condition or disability. We assessed risk of bias using a modification of the Consensus-Based Standards for the Selection of Health Status Measurement Instruments. We explored measurement accuracy for steps, energy expenditure, sleep, time in activity, and distance using group percentage differences as the common rubric for error comparisons. We conducted descriptive analyses for frequency of accuracy comparisons within a ±3% error in controlled and ±10% error in free-living settings and assessed for potential bias of over- or underestimation. We secondarily explored how variations in body placement, ambulation speed, or type of activity influenced accuracy. RESULTS: We included 67 studies. Consistent evidence indicated that Fitbit devices were likely to meet acceptable accuracy for step count approximately half the time, with a tendency to underestimate steps in controlled testing and overestimate steps in free-living settings. Findings also suggested a greater tendency to provide accurate measures for steps during normal or self-paced walking with torso placement, during jogging with wrist placement, and during slow or very slow walking with ankle placement in adults with no mobility limitations. Consistent evidence indicated that Fitbit devices were unlikely to provide accurate measures for energy expenditure in any testing condition. Evidence from a few studies also suggested that, compared with research-grade accelerometers, Fitbit devices may provide similar measures for time in bed and time sleeping, while likely markedly overestimating time spent in higher-intensity activities and underestimating distance during faster-paced ambulation. However, further accuracy studies are warranted. Our point estimations for mean or median percentage error gave equal weighting to all accuracy comparisons, possibly misrepresenting the true point estimate for measurement bias for some of the testing conditions we examined. CONCLUSIONS: Other than for measures of steps in adults with no limitations in mobility, discretion should be used when considering the use of Fitbit devices as an outcome measurement tool in research or to inform health care decisions, as there are seemingly a limited number of situations where the device is likely to provide accurate measurement.

Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study.

BACKGROUND: Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive. OBJECTIVE: We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis. METHODS: We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes. RESULTS: We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m2; delayed: mean 29.2, SD 4.8 kg/m2). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention. CONCLUSIONS: Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management. TRIAL REGISTRATION: ClinicalTrials.gov NCT02315664; https://clinicaltrials.gov/ct2/show/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC).

Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy.

BACKGROUND: We used High Resolution - peripheral Quantitative CT (HR-pQCT) imaging to examine peri-articular bone quality in early rheumatoid arthritis (RA) and explore whether bone quality improved over 12-months in individuals receiving care consistent with practice guidelines. METHODS: A 1-year longitudinal cohort study (Baseline and 12-months) evaluating individuals with early RA compared to age/sex-matched peers. Personal demographic and health and lifestyle information were collected for all. Whereas, active joint count (AJC28), functional limitation, and RA medications were also collected for RA participants. HR-pQCT imaging analyses quantified bone density and microstructure in the Metacarpal Head (MH) and Ultra-Ultra-Distal (UUD) radius at baseline and 12-months. Analyses included a General Linear Modelling repeated measures analyses examined main effects for disease, time, and interaction on bone quality. RESULTS: Participants (n = 60, 30 RA/30 NRA); 80% female, mean age 53 (varying from 21 to 74 years). At baseline, RA participants were on average 7.7 months since diagnosis, presenting with few active joints (AJC28: 30% none, remaining 70% Median 4 active joints) and minimal self-reported functional limitation (mHAQ-DI0-3: 0.56). At baseline, 29 of 30 RA participants had received one or more non-biologic disease-modifying anti-rheumatic drugs (DMARD);13 in combination with glucocorticoid and 1 in combination with a biologic medication. One participant only received glucocorticoid medication. Four RA participants withdrew leaving 26 pairs (n = 52) at 12-months; 23 pairs (n = 46) with UUD and 22 pairs (n = 44) with MH baseline and 12-month images to compare. Notable RA/NRA differences (p < 0.05) in bone quality at all three sites included lower trabecular bone density and volume, more rod-like trabeculae, and larger and more variable spaces between trabeculae; fewer trabeculae at the UUD and MH2 sites; and lower cortical bone density and volume in the MH sites. Rate of change over 12-months did not differ between RA/NRA participants which meant there was also no improvement over the year in RA bone quality. CONCLUSIONS: Early changes in peri-articular bone density and microstructure seen in RA are consistent with changes more commonly seen in aging bone and are slow or resistant to recover despite well controlled inflammatory joint symptoms with early DMARD therapy.

A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study.

BACKGROUND: Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. OBJECTIVE: The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA. METHODS: We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. RESULTS: We identified 46 eligible individuals; of those, 34 (74%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. CONCLUSIONS: This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA. TRIAL REGISTRATION: ClinicalTrials.gov NCT02313506; https://clinicaltrials.gov/ct2/show/NCT02313506 (Archived by WebCite at http://www.webcitation.org/6r4P3Bub0).

A technology-enabled Counselling program versus a delayed treatment control to support physical activity participation in people with inflammatory arthritis: study protocol for the OPAM-IA randomized controlled trial.

BACKGROUND: Being physically active is an essential component of successful self-management for people with inflammatory arthritis; however, the vast majority of patients are inactive. This study aims to determine whether a technology-enabled counselling intervention can improve physical activity participation and patient outcomes. METHODS: The Effectiveness of Online Physical Activity Monitoring in Inflammatory Arthritis (OPAM-IA) project is a community-based randomized controlled trial with a delayed control design. We will recruit 130 people with rheumatoid arthritis or systemic lupus erythematosus, who can be physically active without health professional supervision. Randomization will be stratified by diagnosis. In Weeks 1-8, participants in the Immediate Group will: 1) receive education and counselling by a physical therapist (PT), 2) use a Fitbit and a new web-based application, FitViz, to track and obtain feedback about their physical activity, 3) receive 4 biweekly follow-up calls from the PT. Those in the Delayed Group will receive the same program in Week 10. We will interview a sample of participants about their experiences with the intervention. Participants will be assessed at baseline, and Weeks 9, 18 and 27. The primary outcome measure is time spent in moderate/vigorous physical activity in bouts of ≥ 10 min, measured with a portable multi-sensor device in the free-living environment. Secondary outcomes include step count, time in sedentary behaviour, pain, fatigue, mood, self-management capacity, and habitual behaviour. DISCUSSION: A limitation of this study is that participants, who also administer the outcome measures, will not be blinded. Nonetheless, by customizing existing self-monitoring technologies in a patient-centred manner, individuals can be coached to engage in an active lifestyle and monitor their performance. The results will determine if this intervention improves physical activity participation. The qualitative interviews will also provide insight into a paradigm to integrate this program to support self-management. TRIAL REGISTRATION: Date of last update in ClinicalTrials.gov: September 18, 2015. ClinicalTrials.gov Identifier: NCT02554474.

SenseWearMini and Actigraph GT3X Accelerometer Classification of Observed Sedentary and Light-Intensity Physical Activities in a Laboratory Setting.

Purpose: To compare the ability of SenseWear Mini (SWm) and Actigraph GT3X (AG3) accelerometers to differentiate between healthy adults' observed sedentary and light activities in a laboratory setting. Methods: The 22 participants (15 women, 7 men), ages 19 to 72 years, wore SWm and AG3 monitors and performed five sedentary and four light activities for 5 minutes each while observed in a laboratory setting. Performance was examined through comparisons of accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Correct identification of both types of activities was examined using area under the receiver operating characteristic curve (AUC). Results: Both monitors demonstrated excellent ability to identify sedentary activities (sensitivity>0.89). The SWm monitor was better at identifying light activities (specificity 0.61-0.71) than the AG3 monitor (specificity 0.27-0.47) and thus also showed a greater ability to correctly identify both sedentary and light activities (SWm AUC 0.84; AG3 AUC 0.62-0.73). Conclusions: SWm may be a more suitable monitor for detecting time spent in sedentary and light-intensity activities. This finding has clinical and research relevance for evaluation of time spent in lower intensity physical activities by sedentary adults.

Objectif : Comparer la capacité des accéléromètres Sensewear Mini (SWm) et Actigraph GT3X (AG3) de distinguer les activités sédentaires et d'intensité légère d'adultes en bonne santé observés en laboratoire. Méthodes : Les 22 participants (15 femmes), âgés de 19 à 72 ans, ont porté des moniteurs SWm et AG3 et se sont livrés à cinq activités sédentaires et quatre activités d'intensité légère pendant cinq minutes dans chaque cas sous observation en laboratoire. On a analysé le rendement des appareils en comparant leur exactitude, sensibilité, spécificité et leurs valeurs prédictives positive et négative et ratios de probabilité positif et négatif. On a examiné la détermination correcte des deux types d'activités au moyen de la zone située sous les courbes des caractéristiques opérationnelles du récepteur (ZSC). Résultats : Les deux moniteurs ont démontré une excellente capacité de déterminer les activités sédentaires (sensibilité>0,89). Le moniteur SWm était meilleur pour déterminer les activités d'intensité légère (spécificité variant de 0,61 à 0,71) que le moniteur AG3 (spécificité variant de 0,27 à 0,47) et a donc montré une plus grande capacité de déterminer correctement les activités sédentaires et les activités d'intensité légère (ZSC: SWm=0,84; AG3: variant de 0,62 à 0,73). Conclusions : Le moniteur SWm peut convenir mieux pour détecter le temps consacré à des activités sédentaires et d'intensité légère. Cette constatation présente une pertinence clinique et de recherche pour l'évaluation du temps consacré aux activités physiques de plus faible intensité par des adultes sédentaires.

Treating hand fractures: population-based study of acute health care use in British Columbia.

OBJECTIVE: To examine trends in use of acute health care services for hand fractures in a large diverse population across a range of medical settings. DESIGN: Retrospective review of data from the British Columbia Linked Health Dataset on patients who had been treated for hand fractures between May 1, 1996, and April 30, 2001. SETTING: British Columbia. PARTICIPANTS: A total of 72 481 British Columbia residents identified from the British Columbia Linked Health Dataset as having received treatment for hand fractures. MAIN OUTCOME MEASURES: Initial treatment for fractures (who had provided treatment and where had the treatment taken place) and hospital use (type of hospital, physician responsible, wait time, length of stay,geographic variation). RESULTS: Almost all patients (97%) with hand fractures received initial treatment as outpatients. Just over half these patients (54%) received initial care in nonhospital settings, and more than two-thirds (70%) received initial care from primary care physicians. By far most patients (90%) were treated conservatively without surgical intervention. The few patients with more complicated hand fractures (10%) were most commonly treated in day surgery settings by specialist surgeons within 2 days of first presentation. Patients in the more rural, isolated,northern region of British Columbia had higher hospital admission rates (relative risk 2.1) for hand fractures than patients in other regions did. CONCLUSION: In contrast to other common fracture injuries that are routinely managed by specialist surgeons,most hand fractures in BC were managed initially as nonemergency medical problems by primary care physicians. Almost all patients were treated conservatively without surgical intervention. The few patients with more complicated hand fractures were referred to and treated quickly by specialist surgeons. Focused training and continuing education opportunities for primary care physicians on new approaches to management of acute hand fractures will ensure that patients with hand fractures in British Columbia and the whole of Canada continue to benefit from appropriate management by primary care physicians.

Early controlled passive motion improves early fracture alignment and structural properties in a closed extra-articular metacarpal fracture in a rabbit model.

PURPOSE: To investigate if early controlled passive mobilization was likely to cause harm with regard to affecting the quality and rate of early fracture healing in a closed, potentially unstable, diaphyseal fracture in a rabbit model. METHODS: This was a preclinical, block-randomized, single-blind efficacy trial examining 3 time periods (baseline [day 5], day 14, day 28) and 2 treatment conditions (immobilization, passive motion). Fifty mature, female, New Zealand white rabbits were preconditioned to a non-weight-bearing brace before creating a closed third metacarpal fracture. Fractures were reduced under fluoroscopy and placed in a custom-molded fracture brace. On day 5, rabbits randomly allocated to the early passive motion protocol received twice-daily 15-minute sessions of passive digital motion combined with gentle pinch stabilization of the fracture. Outcome evaluations included lateral x-rays, peripheral quantitative computerized tomography imaging, and 4-point bending to structural failure. RESULTS: Compared with the immobilized fractures, the early controlled passive motion fractures showed significantly better gains in initial stiffness, maximum stiffness, failure load, and energy absorbed per unit area, as well as showing a significant reduction in dorsal fracture angulation. The total callus area was not significantly different between the 2 groups. CONCLUSIONS: During the initial 28 days after the fracture, in this simulated hand, closed, potentially unstable, extra-articular fracture, the early controlled passive motion protocol used in this study led to a clinical and statistical significant reduction in fracture dorsal angulation and improvement in the fracture's ability to resist and bear 4-point bending loads without increasing the total callus area. Therefore, early controlled passive mobilization after a closed, potentially unstable, diaphyseal hand fracture warrants further clinical consideration.

Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study.

PURPOSE: To identify population-based hand fracture annual incidence rates, demographics, and seasonal and geographic variations from all patients seeking treatment for a hand fracture in British Columbia, Canada from May 1, 1996 to April 20, 2001. METHODS: All Medical Service Plan and Hospital Separation records that included International Classification of Diseases-9 codes for metacarpal (815), phalangeal (816), and multiple (817) fractures were extracted from the British Columbia Linked Health Dataset, along with the individual registry demographic records linked to each hand fracture. RESULTS: A total of 72,481 hand fractures were identified. Fifty percent were phalangeal fractures, 42% were metacarpal fractures, and 8% were multiple fractures. The total population annual incidence rate for a hand fracture was 36 per 10,000. Age-adjusted annual incidence rates ranged from 29 per 10,000 for people older than 20 years to 61 per 10,000 for people age 20 or younger. The most common age for a hand fracture was 14 years for males and 13 years for females. Males had a 2.08 greater relative risk for hand fracture and they maintained most of this increase in risk between the ages of 15 and 40. For females there was an increased relative risk for a hand fracture after the age of 65. Spring had the highest rates for hand fractures. People in the Northern half of the province had a 1.6 greater relative risk for sustaining a hand fracture, compared with people in the more urbanized, less-industrialized, and more-affluent Southwestern region. CONCLUSIONS: Our study provides a robust projection of annual incidence rates for hand fractures because we were able to review all occurrences of a hand fracture within a population base of approximately 4 million people over a 5-year period. Our study also allowed for the examination of how age, gender, season, and geographic location influenced hand fracture incidence rates within a large, diverse population.

Is there evidence for early mobilization following an extraarticular hand fracture?

The authors conducted a systematic review to determine if there is scientifically valid (level I or II) evidence for the effect of early motion (<21 days) of joints surrounding an extraarticular hand fracture on fracture healing or functional outcomes. Two reviewers independently evaluated for study inclusion, trial quality and internal validity. Six poor-quality, quasirandomized studies (level III evidence) involving 459 patients were included. Findings suggest that in simple, closed metacarpal fractures, early motion (EM) has the potential to: (1) result in earlier recovery of mobility and strength, (2) facilitate an earlier return to work, and (3) not affect fracture alignment. Findings also indicate that skin pressure problems are not associated with custom-molded metacarpal fracture braces. The scientific validity of EM interventions after an extraarticular hand fracture has not been established in well-conducted, randomized, controlled trials (level I or II evidence). Current evidence does not support or refute the use of EM after an extraarticular hand fracture. However, further investigations are warranted, as findings to date show a consistent potential for benefit with no significant risk of harm when early regional joint motions are incorporated into the management of closed, extraarticular, finger metacarpal fractures.